Prevalence and outcome of systemic fungal infections in renal transplant recipients : a tertiary care experience

• Published in: Saudi journal of kidney diseases and transplantation Vol. 30; no. 5; pp. 1137 - 1143
• Main Authors: Elumalai, Ram Prasad, Shekar, Manikantan, Elayaperumal, Indhumathi, Yelahanka, Renuka Prasad, Anandkumar, Deepashree G., Bandi, Varun Kumar, Matcha, Jayakumar
• Format: Journal Article
• Language: English
• Published: Riyadh, Saudi Arabia Saudi Center for Organ Transplantation 01-09-2019; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Adult; Antifungal agents; Antithymocyte globulin; Basiliximab; Care and treatment; Complications and side effects; Development and progression; Female; Fungal infections; Fungi; Health risk assessment; Humans; Immunocompromised Host; Immunosuppressive Agents - adverse effects; India - epidemiology; Infection; Invasive Fungal Infections - epidemiology; Invasive Fungal Infections - microbiology; Invasive Fungal Infections - mortality; Invasive Fungal Infections - therapy; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Monoclonal antibodies; Morbidity; Mortality; Mycoses; Opportunistic Infections - epidemiology; Opportunistic Infections - microbiology; Opportunistic Infections - mortality; Opportunistic Infections - therapy; Organ transplant recipients; Prevalence; Retrospective Studies; Risk Assessment; Risk Factors; Surveillance; Tertiary Care Centers; Time Factors; Transplants & implants; Treatment Outcome; Viral infections; India; Saudi Arabia
• ISSN: 1319-2442; 2320-3838
• DOI: 10.4103/1319-2442.270270

Fungal infections are an important cause of morbidity and mortality in renal
transplant recipients. These infections account for 5% of all infections in renal transplant
recipients. The symptoms of systemic fungal infections are nonspecific, particularly in their early
stages, and this can lead to delay in diagnosis. Retrospective analysis was conducted on all renal
transplants that were performed at our center over a 20-year period from 1996–2016. Cases of
invasive fungal infections (IFIs) that occurred among renal transplant recipients were identified to
describe the epidemiology of these infections. A total of 67 (9.2%) IFI cases were identified
among 725 renal transplant recipients. Of the 67 patients (9.24%) with IFI, 31 (46.2%) cases were
seen in deceased donor transplant recipients. Of 67 cases with IFI, 42 (62.7%) had received
induction therapy. The incidence of fungal infections according to the induction agent used was,
14.3% with basiliximab, 12.3% each with daclizumab and rabbit antithymocyte globulin, and
6.3% among patients not given any induction. Invasive candidiasis was the most common IFI
overall, followed by mucormycosis, invasive aspergillosis, and cryptococcosis. Median time to
onset of IFI was 117.9 days. Majority of infections occurred within 180 days after transplantation.
Late posttransplant (>180 days after transplantation) IFI’s were predominantly caused by
Candida, followed by Cryptococcus. The longest time to infection was a case of histoplasma,
occurring seven years posttransplant. The overall 12-month cumulative incidence (CI) for any IFI
was 9.1%. The 12-month CI of the first IFI increased from 7.3% between 1996 and 2001 to 10.5%
between 2010 and 2016. The overall mortality rate was 38.8%. The use of newer and more-effectiveimmunosuppressive agents in recent years are
associated with increased rates of fungal
infections in renal transplant recipients.
Therefore, early detection of fungal infections
and proper therapy are important in improving
survival and reducing mortality.